Effects of Controlled Hypotension on Cerebra: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Yu , CUI Yu , LIU Xinzhu ,  LIU Bin

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LIU Bin, Email: benbinliu@hotmail.com

Keywords：

Controlled hypotension; Cerebra; Randomized controlled trial; Systematic review

DOI：

10.7507/1672-2531.20090018

Video：

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Objective 　To determine the effects of controlled hypotension (CH) on cerebra1 blood flow, cerebra1metabolism, and cognitive functions.
Methods 　Randomized controlled trials (RCTs) were identified from MEDLINE (1966 to 2008), EMbase (1974 to 2008), The Cochrane Library (Issue 2, 2008), CBM (1978 to 2008), and CNKI (1994 to 2008). The quality of included trials was assessed by two reviewers independently. RevMan 4.2.7 software provided by The Cochrane Collaboration was used for statistical analysis.
Results 　Nine RCTs involving a total of 295 patients were included. Most of the studies were of poor methodological quality. Meta-analysis was performed because the outcomes were the comparisons of the means of several repeated measures, and so a descriptive analysis was conducted. There were no significant differences in cerebral blood flow velocity, hypoxia-induced metabolites, and cognitive function between the CH group and the control group (P lt;0.05). But the S100B protein level in cerebrospinal fluid or blood was significantly higher in the CH group than that in the control group (P lt;0.02).
Conclusion 　 CH has no adverse effects on cerebra1 blood flow, cerebra1 metabolism, or cognitive functions. But isoflurane-induced hypotension may increase the release of S100B, indicating worse brain injury. The above conclusions were made from the limited evidence, and more rigorous RCTs are needed.

Citation： WANG Yu,CUI Yu,LIU Xinzhu,LIU Bin. Effects of Controlled Hypotension on Cerebra: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(1): 88-92. doi: 10.7507/1672-2531.20090018 Copy

1.	王婷. 血液稀释联合控制性降压对机体生理的影响. 国外医学麻醉学与复苏分册, 2002, 23(6): 355-357.
2.	Mincheff Ms, Meryman HI. Blood tranfusion, blood storuge, and immunodulation. Immunol Invest, 1995, 24(12): 303.
3.	邓硕曾. 输血与血浆代用品. 见: 陈伯鉴, 主编. 临床药理学. 第1版. 北京: 人民卫生出版社, 2000. 580-593.
4.	Chen SY, Zhu XL, Zhang YM, et al. Clinical application of intraoperative autologous blood transfusion. Di-si jun yi Daxue Xubao (J Fourth Mil MedUniv), 2001, 22(6): 542-544.
5.	安刚. 管理循环的技术－控制性低血压. 引进国外医药技术与设备, 1999, 5(11): 11.
6.	黄美清. 控制性降压在临床麻醉中的应用进展. 华夏医学, 2002, 15(3): 425-427.
7.	Degoute CS, Ray MJ, Manchon M, et al. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anesth, 2001, 48(1): 20-27.
8.	计根林, 张进, 熊东方, 等. 尼卡地平和乌拉地尔经蝶垂体腺瘤术中迅速降压效果的比较. 第四军医大学学报, 2000, 21(9): 1118-1120.
9.	王天龙, 齐淡琴. 尼卡地平在临床麻醉中的应用. 国外医学•麻醉学与复苏分册, 2000, 21(1): 40-43.
10.	Endoh H, Honda T, Ohashi S, et al. The influence of nicardipin-, nitroglycerin-and prostaglandin El-induced hypotension on cerebral pressure autoreguration in adult patients during propofol-fentanyl anesthesia. Anesth Analg, 2002, 94(1): 169-173.
11.	Endoh H, Honda T, Komura N, et al. The effects of nicardipine on dynamic cerebral auto regulation in patients anesthetized with propofol and fentanyl. Anesth Analg, 2000, 91(3): 642-646.
12.	Sartcaoglu F, Celiker V, Basgul E, et al. The effect of hypotensive anaesthesia on cognitive functions and recovery at endoscopic sinus surgery. Eur J Anaesthesiol, 2005, 22(2): 157-159.
13.	Suttner SW, Piper SN, Lang K, et al. Cerebral effects and blood sparing efficiency of sodium nitroprusside-induced hypotension alone and in combination with acute normovolaemic haemodilution. Br J Anaesth, 2001, 87(5): 699-705.
14.	Thompson GE, Miller RD, Stevens WC, et al. Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver, and kidney). Anesthesiology, 1978, 48(2): 91-96.
15.	韩如泉, 李树人, 王保国, 等. 异氟醚控制性降压对颅内动脉瘤夹闭术病人脑脊液中S100B蛋白含量的影响. 中华麻醉学杂志, 2004, 24(4): 272-275.
16.	韩如泉, 凌大林, 李树人, 等. 异氟醚控制性降压对颅内动脉瘤夹闭术血中S100B含量的影响. 临床麻醉学杂志, 2004, 20(1): 13-15.
17.	林才珠, 张良成, 杨锡馨, 等. 硝普钠控制性降压对脑脊液和血中乳酸浓度的影响. 中华麻醉学杂志. 1994, 14(5): 352-354.
18.	王秋筠, 孟庆云, 柳顺锁, 等. 七氟醚控制性降压对脑代谢的影响. 中华麻醉学杂志, 2000, 20(5): 270-273.
19.	徐仲煌, 任洪智, 黄宇光, 等. 控制性降压期间脑组织血流及氧供需平衡状况的临床研究. 中国医学科学院学报, 2000, 22(4): 360-363.
20.	张素和, 丁叁强, 杨少辉. 异丙酚控制性降压对颅脑手术脑氧供需平衡的影响. 贵州医药, 2001, 25(6): 500-502.
21.	林财珠, 张良成, 赵建英, 等. 颅脑手术控制性降压时脑脊液乳酸含量变化的观察. 临床麻醉学杂志, 1994, 10(6): 337-338.
22.	王秋筠, 孟庆云, 柳顺锁, 等. 七氟醚控制性降压对脑氧供需平衡的影响. 临床麻醉学杂志, 2000, 16(8): 385-387.
23.	Michenfelder JD, Theye RA. Canene systemic and cerebral effects of hypotension induced by hemorrhage, trimethaphan, halothane, or nitroprusside. Anesth, 1977, 46: 188-195.
24.	Persson L, Hardemark HG, Gustafsson J, el a1. S-lO0 protein and neuronspecific enolase in cerebrospinal fluid and serum：markers of cell damage in human centra1 nervous system. Stroke, 1987, 18: 911-918.
25.	Wiesmann M, Missler U, Hagenstrom H, et a1. S-100 protein plasma levels after aneurysmal subarachnoid haemorrhage. Acta Neurochir(Wien), l997, 139: 1155-1160.
26.	Shaaban Ali M, Harmer M, Vaughan R. Serum S100 protein as a marker of cerebral damage during cardiac surgery. Br J Anoesth, 2000, 85: 287-298.
27.	Johnsson P. Markers of cerebral ischemia after cardiac surgery. Cardiothorac Vasc Anesth, 1996, 10: 120-126.
28.	Ingebrigtsen T, Romner B. Serial S-100 protein serum measurements related to early magnetic resonance imaging after minor head injury. Case report. J Neurosurg, 1996, 85: 945-948.
29.	Kilminster S, Treasure T, McMillan T, et al. Neuropsychological change and S-100 protein release in 130 unselected patients undergoing cardiac surgery. Stroke, 1999, 30: 1869-1874.
30.	Herrmann M, Ebert AD, Galazky l, et al. Neurobehavioral outcome prediction after cardiac surgery - role of neurobiochemical markers of damage to neuronal and glial brain tissue. Stroke, 2000, 31: 645-650.
31.	Pasch T, Huk W. Cerebral complications following induced hypotension. Eur J Anaesthesiol, 1986, 3: 299-312.
32.	Townes BD, Dikmen SS, Bledsoe SW. Neuropsychological changes in a young, healthy population after controlled hypotensive anesthesia. Anesth-Analg, 1986, 65(9): 955-999.
33.	Williams-Russo P, Sharrock NE, Mattis S, et al. Randomized trial of hypotensive epidural anesthesia in older adults. Anesthesiology, 1999, 91: 926-935.

1. 王婷. 血液稀释联合控制性降压对机体生理的影响. 国外医学麻醉学与复苏分册, 2002, 23(6): 355-357.
2. Mincheff Ms, Meryman HI. Blood tranfusion, blood storuge, and immunodulation. Immunol Invest, 1995, 24(12): 303.
3. 邓硕曾. 输血与血浆代用品. 见: 陈伯鉴, 主编. 临床药理学. 第1版. 北京: 人民卫生出版社, 2000. 580-593.
4. Chen SY, Zhu XL, Zhang YM, et al. Clinical application of intraoperative autologous blood transfusion. Di-si jun yi Daxue Xubao (J Fourth Mil MedUniv), 2001, 22(6): 542-544.
5. 安刚. 管理循环的技术－控制性低血压. 引进国外医药技术与设备, 1999, 5(11): 11.
6. 黄美清. 控制性降压在临床麻醉中的应用进展. 华夏医学, 2002, 15(3): 425-427.
7. Degoute CS, Ray MJ, Manchon M, et al. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anesth, 2001, 48(1): 20-27.
8. 计根林, 张进, 熊东方, 等. 尼卡地平和乌拉地尔经蝶垂体腺瘤术中迅速降压效果的比较. 第四军医大学学报, 2000, 21(9): 1118-1120.
9. 王天龙, 齐淡琴. 尼卡地平在临床麻醉中的应用. 国外医学•麻醉学与复苏分册, 2000, 21(1): 40-43.
10. Endoh H, Honda T, Ohashi S, et al. The influence of nicardipin-, nitroglycerin-and prostaglandin El-induced hypotension on cerebral pressure autoreguration in adult patients during propofol-fentanyl anesthesia. Anesth Analg, 2002, 94(1): 169-173.
11. Endoh H, Honda T, Komura N, et al. The effects of nicardipine on dynamic cerebral auto regulation in patients anesthetized with propofol and fentanyl. Anesth Analg, 2000, 91(3): 642-646.
12. Sartcaoglu F, Celiker V, Basgul E, et al. The effect of hypotensive anaesthesia on cognitive functions and recovery at endoscopic sinus surgery. Eur J Anaesthesiol, 2005, 22(2): 157-159.
13. Suttner SW, Piper SN, Lang K, et al. Cerebral effects and blood sparing efficiency of sodium nitroprusside-induced hypotension alone and in combination with acute normovolaemic haemodilution. Br J Anaesth, 2001, 87(5): 699-705.
14. Thompson GE, Miller RD, Stevens WC, et al. Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver, and kidney). Anesthesiology, 1978, 48(2): 91-96.
15. 韩如泉, 李树人, 王保国, 等. 异氟醚控制性降压对颅内动脉瘤夹闭术病人脑脊液中S100B蛋白含量的影响. 中华麻醉学杂志, 2004, 24(4): 272-275.
16. 韩如泉, 凌大林, 李树人, 等. 异氟醚控制性降压对颅内动脉瘤夹闭术血中S100B含量的影响. 临床麻醉学杂志, 2004, 20(1): 13-15.
17. 林才珠, 张良成, 杨锡馨, 等. 硝普钠控制性降压对脑脊液和血中乳酸浓度的影响. 中华麻醉学杂志. 1994, 14(5): 352-354.
18. 王秋筠, 孟庆云, 柳顺锁, 等. 七氟醚控制性降压对脑代谢的影响. 中华麻醉学杂志, 2000, 20(5): 270-273.
19. 徐仲煌, 任洪智, 黄宇光, 等. 控制性降压期间脑组织血流及氧供需平衡状况的临床研究. 中国医学科学院学报, 2000, 22(4): 360-363.
20. 张素和, 丁叁强, 杨少辉. 异丙酚控制性降压对颅脑手术脑氧供需平衡的影响. 贵州医药, 2001, 25(6): 500-502.
21. 林财珠, 张良成, 赵建英, 等. 颅脑手术控制性降压时脑脊液乳酸含量变化的观察. 临床麻醉学杂志, 1994, 10(6): 337-338.
22. 王秋筠, 孟庆云, 柳顺锁, 等. 七氟醚控制性降压对脑氧供需平衡的影响. 临床麻醉学杂志, 2000, 16(8): 385-387.
23. Michenfelder JD, Theye RA. Canene systemic and cerebral effects of hypotension induced by hemorrhage, trimethaphan, halothane, or nitroprusside. Anesth, 1977, 46: 188-195.
24. Persson L, Hardemark HG, Gustafsson J, el a1. S-lO0 protein and neuronspecific enolase in cerebrospinal fluid and serum：markers of cell damage in human centra1 nervous system. Stroke, 1987, 18: 911-918.
25. Wiesmann M, Missler U, Hagenstrom H, et a1. S-100 protein plasma levels after aneurysmal subarachnoid haemorrhage. Acta Neurochir(Wien), l997, 139: 1155-1160.
26. Shaaban Ali M, Harmer M, Vaughan R. Serum S100 protein as a marker of cerebral damage during cardiac surgery. Br J Anoesth, 2000, 85: 287-298.
27. Johnsson P. Markers of cerebral ischemia after cardiac surgery. Cardiothorac Vasc Anesth, 1996, 10: 120-126.
28. Ingebrigtsen T, Romner B. Serial S-100 protein serum measurements related to early magnetic resonance imaging after minor head injury. Case report. J Neurosurg, 1996, 85: 945-948.
29. Kilminster S, Treasure T, McMillan T, et al. Neuropsychological change and S-100 protein release in 130 unselected patients undergoing cardiac surgery. Stroke, 1999, 30: 1869-1874.
30. Herrmann M, Ebert AD, Galazky l, et al. Neurobehavioral outcome prediction after cardiac surgery - role of neurobiochemical markers of damage to neuronal and glial brain tissue. Stroke, 2000, 31: 645-650.
31. Pasch T, Huk W. Cerebral complications following induced hypotension. Eur J Anaesthesiol, 1986, 3: 299-312.
32. Townes BD, Dikmen SS, Bledsoe SW. Neuropsychological changes in a young, healthy population after controlled hypotensive anesthesia. Anesth-Analg, 1986, 65(9): 955-999.
33. Williams-Russo P, Sharrock NE, Mattis S, et al. Randomized trial of hypotensive epidural anesthesia in older adults. Anesthesiology, 1999, 91: 926-935.

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Chinese Journal of Evidence-Based Medicine

Effects of Controlled Hypotension on Cerebra: A Systematic Review

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